Application
Date
*
-
Month
-
Day
Year
Company Name
*
Business Category
*
Life Sciences
Technology
Other
Minority Owned Business
*
Yes
No
Minority Owned Business Details
*
Minority
Veteran
Woman
Venture Address (You and or your venture must have a nexus to Maryland)
Street 1
*
Street 2
City
*
County
*
Maryland County Name (Do not include the word "County")
State
*
Postal Code
*
Venture Executive Leader - First Name
*
Venture Executive Leader - Last Name
*
Please check one of the following groups in which you consider yourself to be a member
*
Please Select
American Indian or Alaska Native
Asian
Black or African American
Hispanic
Latino
Native Hawaiian or Other Pacific Islander
White
Other
Do you work full time on this venture?
*
Yes
No
If no, please provide more information
*
0/100
Email
*
example@example.com
Primary Phone
*
Please enter a valid phone number.
Title
*
Referred by
*
What do you do? Please provide a succinct 2-3-sentence description of what you do.
*
Briefly describe the status of the current marketing, funding and staffing.
*
What is the problem? In a few sentences, please describe what problem you are solving.
*
Are you currently generating revenue? If not, How will you make money? In a few sentences, describe who will pay you and how you envision selling to them
*
What is the secret sauce? In a few sentences, please describe what is special about your solution and product.
*
Describe the IP status.
*
What type(s) of assistance are you seeking?
*
Business Development
IP Strategy
Commercial potential of technology
Team Formation
Informal Feedback
Additional Comments
*
List other mentoring services or programs you have received
*
Attach Bio
*
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Submit current Executive Summary or pitch deck
*
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